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Sunday, 27 November 2005

Unparty column

It’s my party, and I’ll vie if I want toBy BRAD WARTHENEditorial Page EditorINSPIRED BY Ariel Sharon’s decision to abandon the Likud Party he helped build and start another, more centrist one — one that immediately began to catch on to the extent that it looks as though it will propel him past the established factions and into another term in office — I posted a blog item last week that asked, “Why can’t we do this here?” Excited at the idea of “giving those of us in the sensible middle an actual alternative to the mutually exclusive, mutually loathing Democrats and Republicans,” I got right to the business of setting up my own faction, posing such questions as: What would be the precepts of such a party? What should we call it? Who would be some good candidates? What animal should be our mascot?My respondents quickly brought me down to Earth. I heard from both sides of the partisan divide, and the more ardent were soon ignoring my questions and clawing each other. But both sides seemed to agree that those of us who eschew the current phony ideologies don’t believe in anything ardently enough to get things done. What a relief when “David” spoke for me by writing, “I am always intrigued by this argument that moderates aren't passionate about anything.... I take every issue on its own merits and when I make up my mind, I am as passionate and diehard about that position as any conservative or liberal could ever be.” Exactly. Why is it so hard for partisans and ideologues to understand that we might hold our own values and positions even more passionately than they hold theirs, for the simple fact that they are ours. We didn’t do what they did, which was to buy an entire set of attitudes off the rack, preselected and packaged by someone else, and chosen based on nothing deeper than brand name. Is there anything wishy-washy about the stands taken by such “moderates” as John McCain and our own Lindsey Graham? Was Joe Lieberman being a fence-sitter when he helped push through the Iraq Liberation Act, which way back in 1998 made the overthrow of Saddam Hussein the official policy of this country? These are the people who take the independent risks that make things happen, from campaign finance reform to banning torture. Without them as pivots, giving ideas credibility by virtue of their own independence, we’d be forever in a state of stalemate, unable to settle any difficult issue. And those of us who support their like are the ones who decide elections
— not the partisans, who can be taken for granted. The best thing is to have no parties. But it’s still fun to imagine what kind of party we who despise them would create if we were so inclined. Let’s give it a go. Right off, I’m stumped as to a name. So for now, let’s just call it the “Unparty.” (After all, the “Uncola” caught on for a while.) Are there any fundamental, nonnegotiable tenets? Sure:

First, unwavering opposition to fundamental, nonnegotiable tenets. Within our party would be many ideas, and in each situation we would sift through them to find the smartest possible approach to the challenge at hand. Another day, a completely different approach might be best.

Respect for any good idea, even if it comes from Democrats or Republicans.

Contempt for any stupid idea, even if it comes from our own party leaders.

Utter freedom to vote however one’s conscience dictates, without condemnation or ostracism from fellow party members.

Every Unpartisan would have his or her own set of positions on issues, having worked them out independently. But to banish the thought that Unpartisans don’t take strong stands, here would be some positions I would bring to the party table (and remember, this is just me, not the editorial board of The State):

Respect for life. Opposition to abortion, the death penalty and torture of prisoners.

Belief in just war theory, and in America’s obligation to use its strength for good. (Sort of like the Democrats before Vietnam.)

A single-payer national health care system — for the sake of business and the workers. If liberals and conservatives could stop driving a wedge between labor and capital for about five minutes, we could make this a reality.

Universal education — as a state, not a national, responsibility. Go ahead and shut down the U.S. Department of Education, and make sure you provide equal educational opportunity for all on the state level.

A rational, nonideological energy policy that will make us independent of despotic foreign regimes: Drill in the ANWR. Impose strict efficiency standards on Detroit. Build more refineries. Since we are at war and they are helping the enemy, build internment camps for Hummer drivers. (OK, scratch that; just make the Humvee like automatic weapons — banned for all but military use. In fact, what was wrong with the Jeep?) Launch a Manhattan Project to find something better than fossil fuels. Take the advice of Charles Krauthammer and set gasoline permanently at $3 a gallon — when the price of crude drops, raise the tax to keep the pump price at $3. Unlike Mr. Krauthammer (who’d use the proceeds for tax cuts), I’d make like a real conservative and balance the budget.

Such ideas are not left, right or wishy-washy. Admittedly, in my zeal to debunk the myth that we “moderates” (an inadequate word, really, for independents) don’t take strong stands, I’ve deliberately chosen some ideas that are attractive to me but are too out there for my own editorial board. (Although the issues they address are similar to some set out by potential Unpartisan Paul DeMarco in comments on my blog.) But wouldn’t that make for some lively Unparty conventions? And wouldn’t they be more worth watching than those scripted, stultifying pep rallies that the Democrats and Republicans hold every four years? I certainly think so. In fact, that’s one point on which most of us Unpartisans could agree.

"The likelihood of being covered by health insurance rised with income. Among people in households with annual incomes of less than $25,000 in 2004, 75.7 % had health insurance; the level increased with income up to 91.6% for those in households with incomes of $75,000."

"Children 12-17 were more likely to be uninsured than those under 12 years old - 12.5% compared with 10.5%. About 21.1 % of Hispanic children did not have any health insurance in 2004, compared with 7.6% for non Hispanic children, 12% black children and 9.4% Asian children."

Should we count illegal immigrants in our estimates of poverty, health care, and education programs? Should we not at least break them out from the citizens? The Census does provide the data.

Census Bureau reports welfare use by household based on the nativity of the household head. See for example, Figures 20-1, 20-2 and 21-3 in ?Profile of the Foreign-Born Population: 2000.? P23-206, U.S. Census Bureau, December 2001. http://www.census.gov/prod/2002pubs/p23-206.pdf.

The Census Bureau in 2001 reported that the number of Americans without health insurance fell to around 38.7 million in 2000, down about 600,000 from 1999 and well below the record 44.3 million who were uninsured in 1998. Many can afford insurance:

* From 1993 to 2000 the number of uninsured people in households with annual incomes above $75,000 increased by 63 percent and the number in households with annual incomes from $50,000 to $75,000 increased by 48.2 percent.

* By contrast, the number of uninsured people in households with incomes under $25,000 fell by 25 percent.

* Almost one-third of the uninsured now live in households with annual incomes above $50,000.

Most people don't plan to get sick. For some, a sudden chest pain is their introduction to the health care system. They call 911 and the ambulance takes them to the nearest hospital. If they are having a heart attack they now face at least a five figure expenditure that a few hours ago when they were rolling out of bed they had no inkling they would incur.

What other service do we purchase like that? Most people spend weeks comparison shopping for a car and can walk away from the deal if not satisfied. When you are acutely ill, you don't have that luxury. Nor does price competition mean much (have your first heart attack at our hospital, get the second at half price?)

I suspect Lee will respond by saying that the luckless dolt that finds himself in an ER having a heart attack without medical insurance deserves what he gets. But, Lee, can you honestly say that if you were making just enough money to get by that you would spend your only bit of discretionary income to buy health insurance for an unanticipated medical emergency? Most people are going to put their money elsewhere.

Dave,

I suspect that the number of physicians has very little effect on medical care costs. I can charge whatever I would like for my services but what I get paid is primarily dictated by insurers (private/Medicare/Medicaid). Perversely, it is only the patients who have no insurance who have to pay full price.

In rural areas, the physician shortage is often because of lifestyle choices on the part of physicians who would rather practice in cities. Often times rural medical care is dispensed by "physician extenders" (physician's assistants or nurse practitioners) whose salaries are less than MDs so this might actually decrease the cost of care.

You have to take the case of each person who has a medical emergency on its merits. If the person is 500 lbs overweight, could afford insurance, but chose not to buy it and had a heart attack, would "Paul DeMarco" say he is responsible for his situation?

Among Americans with household incomes of $50,000 a year or more = just eight percent are uninsured.

Among those with incomes under $50,000, the number of uninsured swells to one in five.

Among just those with incomes under $20,000, it grows to nearly one in three.

Another issue is that a lot of those people making over $50,000 a year that are uninsured are SMALL BUSINESS OWNERS. They can't afford health insurance and stay profitable in their business and keep the doors open and their employees half way happy.

Another reason is that some companies just aren't offering health insurance anymore. They have basically got out of the market. So you have full time workers that aren't offered coverage at work and they go out and price health insurance and find that the costs have skyrocketed.

The issue has became so complicated that a figure or a statistic doesn't really tell the story.

I visit businesses every day in South Carolina. Most are small business- under 20 employees and a lot are in fairly rural areas (some aren't). As part of my job I inquire if the company offers health insurance. I don't keep statistics myself but I am always fairly taken off guard if I go into a small business and they offer any type of regular health insurance. A precious few offer a basic plan with a deductible in the $1000-$2000 range.

and I can only end with the experience I had that I mentioned above (and this was my first experience with anything like this because I rarely go to any doctor). I have decent insurance but the specialist I was going to go to wouldn't even let me make the appointment if I hadn't had the right insurance or paid at the beginning of my visit. I was lucky. I probably could do either. But my wife and I talked about what we would have done if we couldn't pay for that visit ourself and we had no or limited insurance. I know I would have been in trouble.

I don't worry so much about myself. But I do worry about a lot of other people that wouldn't have been able to get that appointment. That, my friend, make me think.

Paul, I agree that doctors don't truly set the rates but the prices that insurers pay are set by the UCR mode, Usual, Customary, Reasonable that I know you are familiar with. That is basically a form of price fixing to keep all doctors on an even keel as well as the insurers. As to elective type medical treatment, I think doctors and hospitals should be allowed to advertise. Why not?

I know of two recent situations where a person who had no insurance was "given" half price by a doctor and a dentist. Another indication of the mess the government has created with Medicare and Medicaid.

Small business owners are not permitted the same tax deductions as large businesses who can afford the tax lawyers and accounting staff, and setup fees for defined benefit plans.

The best solution is to get rid of all the large corporate benefit systems, and let each person buy their own insurance and own their own retirement plans, with no legal limits on the levels. Big companies don't want that, because they use their special tax treatment to keep unhappy employees as captives.

I won't try to weigh into this discussion much, since I don't have the time, nor the expertise. But having lived in Europe for nearly 30 years, I do object to Lee's characterization of its health care. Yes, I have read some of the stuff on it, but it is interesting that the people I know, whether in England, Canada, or elsewhere, do not have the opinions that Lee represent. (Instead, almost all of them think our system is barbaric.) And I certainly was glad to have raised our kids in Germany, especially with our son spending weeks at a time in the hospital. I wouldn't want to even calculate what that would have cost here, if the insurance company here would have even let him be in the hospital.

We have to have a system that everybody has to pay into (it's not going to work if people don't pay in until they get sick), and it has to stay lean. It is true that people here want to overspend their credit cards instead of paying for a yearly physical, but government needs to protect its people in that respect too. There are ways to to have very basic coverage for everybody without killing the goose that laid the golden egg.

Keeping such a system lean is admittedly the hard part, but at the very least, I would suggest not characterizing the whole of European medicine with "socialist horror," if one hasn't seen it first hand.

I am not a socialist, but I do think there needs to be some re-distribution of income, otherwise the gap between rich and poor becomes too large, and the accompanying destabilizing effect on society is dangerous. Coming from a guy who started out in Young Republicans working for Goldwater in '64, that is quite a statement!

Re Herb's comments: One principle for success is that everyone must obtain health insurance. Another principle is that the costs of health care administration (including insurance company profits) must be relentlessly monitored. "Socialized medicine" is a dirty phrase, but it also covers a lot of muddleheadedness that could be eliminated without hobbling ourselves economically.

Lee, I realize that we have had our differences, and for the sake of discussion, I am going to say things that you may not like.

Is it really necessary to keep every person on earth alive forever? The earth is overpopulated as is, and with advances in medical technology the problem only gets worse. Perhaps it will be better for mankind if we revert to a little Darwinism, where only the strong survive. (Sorry to all those worshippers of Pat Robertson's God.)

Americans have an unhealthy immunity to death because we are able to keep loved ones hanging on for the sake of the survivors rather than the infirm. I have watched firsthand as my Grandfather has withered, yet been kept alive for the last three years following a major stroke (at a huge expense and against the wishes of his living will).

I am healthy, and rarely need/use health care, yet I pay out of the rear for it. I pay the same amount as every other employee at my company for the same coverage, yet I rarely use it. That seems to be rather socialistic to me.

One more question in this rambling post, but is it just me, or do you remember such a profession as health care administration ten years ago? It seems that there are more administrators than doctors in hospitals these days.

Actually, it is impossible to keep anyone alive forever. Free market medicine just makes it possible to keep more people alive for a longer life. Patients get to decide if they want to pay for continuous care, surgery, and drugs to keep them alive.

Under socialism, the average person has no choice. The state has a financial incentive to kill off pensioners and cure young taxpayers.

That's why all the countries with "universal healthcare" also have expensive medical insurance plans that let the upper echelons buy their way to the head of the waiting list, receive treatment at private clinics, or even out of the country.

Pardon my use of hyperbole. I get angry that I am subsidizing all of the 400 lb. smoking crowds' health insurance.

I believe that there is a little free-marketism in the fact that the upper eschelon don't care because they know that they are free to get health care elsewhere. (at a cost of course) To me it is a little bit of financial Darwinism where it is survival of the richest. If you are welthy you have certain advantages in life. Sad, but true.

I'll counter with: what is the purpose of a longer life if you are confined to a wheelchair or bed?

Most people work harder for material comforts, rather than worrying about death by being kept alive by modern medecine at a huge monetary cost.

If your sole purpose in life is to accumulate wealth to "live longer", then you are fooling yourself, and wasting valuable time dwelling on death.

I work hard to pay the bills, and harder so that I can accumulate wealth, so that I won't have to work hard forever, and in the end I will be more able to enjoy my life so that I won't have to extend it unnecessarily because I feel that I have missed something.

And may I suggest an insignia!? How about a CHAMELEON? It suggests pragmatism, to be able to look at all possibilities, regardless of who propose them - the conservatives or the liberals. And if we fail, we have only to look in the mirror to blame somebody.

When I said "lean and mean," I meant a system that can be tweaked to penalize the 400 lb. smoker. I work for a non-profit and have a very small salary. The only way my wife and I can afford any kind of health insurance in this country is through Christian Care Medishare. Technically, its not insurance, but it requires a commitment to pay one's share each month. The whole point of it is for the stronger to help the weaker. But if you're grossly overweight, they won't let you into it. They won't let you into it if you smoke, either. Those of us who are healthy (and I belong in that category, too) should be thankful, and realize that could change at any time. I had a good friend who was robustly healthy, too, until he got RLS (Lou Gehrig's) at age 50.

Preston,
Get your thoughts in order, then come right out and state if you think state employees and politicians should be telling other people that their lives are not worth continuing, so they are going to be killed?

According to the official reports of various socialist medical systems, in Europe, they deny treatment to thousands of sick patient as a matter of policy, to save money.

The reality is that there is not enough money in the world to buy all the medical care everyone wants. Even the richest people in the world are unable to buy all the medical they want for themselves.

The market allocates medical care to people based on what they really want to pay for.

Socialism allocates medical care to people based on the whim of bureaucrats operating with even less funding than is available in economies which are more free market. They control costs by setting the pay of physicians and nurses below the free market rates, forcing drug companies to sell to the state a prices too low to justify new research, by witholding expensive treatment, and even killing patients.